WORKSHOP OBJECTIVES:
The purpose of the workshop was to assess the current level of medical preparedness for a nuclear detonation of up to 10 kilotons in tier 1 Urban Area Security Initiative cities (New York/New Jersey; National Capitol Region; Houston; Chicago; Los Angeles; and San Francisco/Bay Area). The specific objectives of the workshop were to:
--Review and summarize the overall emergency response activities, and available healthcare capacity (including shelter, evacuation, decontamination, and medical infrastructure interdependencies) to treat the affected population;
--Examine the capacity and identify gaps in the capability of the federal, state, and local authorities to deliver available medical countermeasures in a timely enough way to be effective;
--Review and summarize available treatments for pertinent radiation illnesses including the efficacy of medical countermeasures; and,
--Appraise the expected benefit of medical countermeasures, including those currently under development.
DAY 1 AGENDA
8:30 a.m. Welcome, Introductions, and Overview of Workshop Purpose and Objectives
Georges C. Benjamin, Committee Chair, Executive Director, American Public Health Association
B. Tilman Jolly, Office of Health Affairs, Department of Homeland Security
Session 1: NUCLEAR ATTACK 101: HEALTH & HEALTH SYSTEM IMPACTS OF AN IMPROVISED NUCLEAR DEVICE EXPLOSION
Session Objectives: Provide basic information on the scope of the emergency medical needs that would be created by the detonation of a 10-kiloton (kT) nuclear device in a major city, including primary and secondary blast and thermal effects and the effects of prompt nuclear radiation and radiation from fallout on inhabitants and emergency responders. The main focus will be on the acute injuries caused by the blast, thermal, and prompt radiation effects of the initial explosion and by acute radiation exposure from fallout during the first three days after the explosion (excluding other important but longer-term impacts, such as long-term radiation effects, environmental contamination, and displacement of residents from contaminated areas). The potential impacts of the explosion on local emergency response and health system capacities will also be described. At the end of the session, workshop participants will have a basic understanding of the medical situation faced by emergency responders during the first 3 days post-explosion, which in turn will be the basis for assessing current medical preparedness at the local, state, and federal levels.
9:00 a.m. Session Overview and Objectives
Daniel F. Flynn, Session Moderator, Department of Radiation Oncology, Caritas Holy Family Hospital and Medical Center, Methuen, MA
9:05 a.m. Health Effects of a 10-kT-Equivalent Nuclear Explosion on an Urban Population and Emergency Responders
Brooke Buddemeier, Radiation Safety Specialist, Radiological and Nuclear Countermeasures Division, Global Security Principal Directorate, Lawrence Livermore National Laboratory
9:35 a.m. Health System Impacts of a 10-kT-Equivalent Nuclear Explosion on an Urban Area
Cham Dallas, Director, Institute for Health Management and Mass Destruction Defense; Professor, Department of Health Policy & Management, College of Public Health, University of Georgia; Department of Pharmaceutical & Biomedical Sciences, College of Pharmacy, University of Georgia; Department of Emergency Medicine, Medical College of Georgia
10:05 a.m. Discussion led by Daniel F. Flynn, Session Moderator
10:35 a.m. BREAK
Session 2: EMERGENCY MEDICAL CARE: STATE OF THE ART
Session Objective: Provide an overview of current approaches to medical response in the event of an IND explosion. The first presentation will cover the triage, decontamination, evacuation, and medical care of casualties from the immediate effects of a nuclear detonation, i.e., treatment of blast, thermal, and prompt radiation effects, including combined injuries. The second presentation will cover medical decision making and care of casualties from the delayed effects of a nuclear detonation, i.e., secondary triage and injuries from radioactive fallout.
10:45 a.m. Session Overview and Objectives
Donna F. Barbisch, Session Moderator, President, Global Deterrence Alternatives, LLC, Washington, DC
10:50 a.m. Urban Nuclear Detonation: Operational Conditions, Human Response and Casualty Management
John Mercier, Director of Military Medical Operations, Armed Forces Radiobiology Research Institute
11:20 a.m. Medical Decision Making and Care of Casualties from Delayed Effects of a Nuclear Detonation
Fred A. Mettler, Jr., Professor Emeritus, Department of Radiology, New Mexico Federal Regional Medical Center, University of New Mexico
11:50 a.m. Discussion led by Donna F. Barbisch, Session Moderator
12:20 p.m. WORKING LUNCH IN THE LECTURE ROOM
Committee, speakers, participants, and staff will briefly recap the discussions from the morning sessions of the first day of the workshop.
Session 3: RADIATION COUNTERMEASURES
Session Objective: Provide an overview of current medical countermeasures for the acute effects of radiation exposure and of their efficacy and an assessment of the expected benefit of medical countermeasures currently under development.
1:30 a.m. Session Overview and Objectives
Richard J. Hatchett, Session Moderator, Associate Director for Radiation Countermeasures Research and Emergency Preparedness, National Institute of Allergy and Infectious Diseases
1:35 p.m. Efficacy and Expected Benefit of Currently Available Radiation Countermeasures
Albert L. Wiley, Jr., Radiation Emergency Assistance Center/Training Site and World Health Organization Collaborating Center for Radiation Emergency Assistance, Oak Ridge Associated Universities
2:05 p.m. Expected Benefit of Radiation Countermeasures Currently under Development
Nelson J. Chao,Professor of Medicine and Immunology, Chief, Division of Cellular Therapy, Duke University Medical Center
2:35 p.m. Distribution and Dispensing of Medical Countermeasures (i.e., how and when will countermeasures get to those who need them?)
Steven A. Adams, Deputy Director, Division of Strategic National Stockpile, Centers for Disease Control and Prevention
Carmen T. Maher, Policy Analyst, Office of Counterterrorism & Emerging Threats, Food and Drug Administration
3:00 p.m. Discussion led by Richard J. Hatchett, Session Moderator
3:30 p.m. BREAK
Session 4: PROTECTIVE ACTIONS AND INTERVENTIONS: PART I
Session Objective: Provide an overview of current policies and programs to protect first responders and medical personnel from radiation exposure.
3:45 p.m. Session Overview and Objectives
Paul E. Pepe, Session Moderator, Professor of Medicine, Surgery, Pediatrics, Public Health; Riggs Family Chair in Emergency Medicine, University of Texas Southwestern Medical Center at Dallas
3:50 p.m. Radiation Protection Standards
Sara D. DeCair, Health Physicist, Center for Radiological Emergency Preparedness, Prevention, and Response, U.S. Environmental Protection Agency
John MacKinney, Deputy Director, Nuclear/Radiological/Chemical Threats and Science and Technology Policy, Office of Policy Development, Department of Homeland Security
Jill A. Lipoti, Director, Division of Environmental Safety and Health, New Jersey Department of Environmental Protection
Eric G. Daxon, Health Physicist, Battelle - San Antonio Operations
4:40 p.m. Discussion led by Paul E. Pepe, Session Moderator
5:10 p.m. ADJOURNMENT OF OPEN SESSION
DAY 2 AGENDA
8:30 a.m. Welcome, Introductions, and Overview of Workshop Purpose and Objectives
Georges C. Benjamin, Committee Chair, Executive Director, American Public Health Association
Session 5: PROTECTIVE ACTIONS AND INTERVENTIONS: PART II
Session Objective: Provide overview of best population protection practices during an IND incident. Issues include risk communication, psychosocial factors, and readiness to implement interventions to reduce mental and physical impacts.
8:45 a.m. Session Overview and Objectives
Robert J. Ursano, Session Moderator, Chairman and Professor of Psychiatry and Neuroscience, Chairman, Department of Psychiatry, Uniformed Services University of the Health Sciences
8:50 a.m. Behavioral and Risk Communication Issues, and Interventions Strategies, in Nuclear Detonation Incidents
Steven M. Becker, Associate Professor of Public Health; Vice Chair, Department of Environmental Health Sciences; Director, Disaster & Emergency Communication Research Unit; Director, Community Resilience & Disaster Management Program, The University of Alabama at Birmingham
H. Keith Florig, Senior Research Engineer, Department of Engineering & Public Policy, Carnegie Mellon University
Ann E. Norwood, Senior Associate, UPMC Center for Biosecurity
Dori B. Reissman, Senior Medical Advisor, Office of the Director, NIOSH
10:20 a.m. BREAK
10:30 a.m. Behavioral and Risk Communication Issues, and Interventions Strategies, in Nuclear Detonation Incidents (continued)
11:00 a.m. Discussion led by Robert J. Ursano, Session Moderator
Session 6: SUMMARY
11:30 a.m. Summary of workshop discussions
Jerome M. Hauer, The Hauer Group
12:00 p.m. Wrap-up and final thoughts
Georges C. Benjamin, Committee Chair
2:30 p.m. ADJOURNMENT OF OPEN SESSION